Outpatient Physical Therapy Management of a Chronic Incomplete Spinal Cord Injury: A Case Report

Background and Purpose. An incomplete cervical spinal cord injury is a lesion to the Cl-C7 area of spinal cord that does not result in a complete disconnection of the spinal cord and brain. Around 18,000 individuals are affected by a spinal cord injury in the United States each year, typically due to traumatic injury such as a motor vehicle accident, falls or violence. Each case presentation can be different with their impairments and functional limitations. Physical Therapists are vital in the examination and evaluation process to determine the severity of impairments secondary to the injury and the overall effects it has on their function, and screen for strength, sensation, transfer abilities, and interview for daily activities that have been affected by the injury. This article describes the 3month outpatient Physical Therapy (PT) management of a 68-year-old male who had a 2-level cervical spinal cord injury resulting in incomplete tetraplegia. The patient presented with generalized muscle weakness, fatigue, and decreased motor function. The purpose of this article was to describe the interventions used for this patient and the positive results these interventions produced to improve the patient\u27s quality of life. Description. The treatment of this patient included aquatic therapy, neuromuscular re-education, stretching, and strengthening. He started with time spend in a stander and gradually was exposed to environments that challenged his abilities. Outcomes. Following 3-months of PT intervention, patient achieved the ability to perform bed mobility and transfers safely with stand by assistance (SBA). He was able to ambulate for 30 ft with moderate assistance and an assistive device. Discussion. The client made significant strides towards his goals of modified independent walking. His combined motivation and physical therapy intervention led to a decrease in fear of falling and an increase in lower extremity strength that allowed him to progress to ambulation with moderate assistance and an appropriate assistive device (AD). Rationale for treatment was based on researched, published information on the treatment of incomplete spinal cord injuries as well as treating the patient\u27s presenting symptoms (i.e. weakness, decreased motor function) with supporting evidence from earlier case reports. Treatment was altered based on patient\u27s response. Conclusion. Aquatic therapy and land-based ambulatory activities were effective in increasing lower extremity strength and coordination. It was expected that the client would continue to improve and would be able to perform household ambulation with an appropriate AD if he continued to choose to participate in PT